The Text is Dead, Long Live the Text

Words by Tanushree Rao

Illustrations by Lauren Conti

This story was first published in Mini Matters.

As SMS becomes slowly replaced by social media and instant messaging there’s a group of mothers in Timor-Leste who are using this ‘outdated system’ as a way to save their own lives and the lives of their babies.

Think back to the last time you sent an SMS. It might have been a few hours ago, or, like this writer, it might have been days or even weeks.

With the advent of WhatsApp, iMessage, Facebook Messenger and several other social channels contributing to this information age, it’s easy to forget about the technology that once saw the numbers 2, 4 and 8 feature more than their linguistic counterparts – “GTG 2 city 4 work, cya l8r”.

But barely an hour’s flight from Darwin in Timor-Leste, a country where the majority of telecommunication infrastructure was destroyed during a past riddled by violent conflict with Indonesia, SMS is far from irrelevant.

After identifying a critical need to improve access to healthcare for mothers and babies, a group of organisations in Timor-Leste has, for the past five years, run the country’s first mobile health program via the use of SMS. NGO Health Alliance International (HAI), tech-for-development organisation, Catalpa International, and the Ministry of Health in Timor-Leste have all been working together to connect pregnant women and mothers in rural areas with midwives and doctors.

Liga Inan, the program’s name, translates from Tetun (one of Timor-Leste’s four principal languages and the most widely spoken since it gained independence in 2002) to ‘Connecting Mothers’, and it’s setting out to improve healthcare across the nation. It works by sending twice-weekly advice via text message to expectant mothers, all texts are tailored to the woman’s stage of pregnancy. These text messages continue for the first six months of their baby’s life, and allow doctors and midwives to track mother and baby’s progress through two-way communication. Pregnant women can also text to request a call, health providers can send public messages about vaccinations or mobile clinics, and midwives are prompted to call prior to delivery dates to discuss birth plans.

Program staff partner with a diverse group of organisations in the health sector to make sure messages are simple, culturally appropriate and able to motivate people to take the right action. “We don’t work alone to produce all the messages,” explains Paul Vasconcelos, Liga Inan’s program director at HAI in Timor-Leste. “We field test them with the mothers and we consult with other partners. We’re trying to help the health sector’s messages come together rather than us saying one thing and someone else saying another.”

The program has now trained around 400 health providers and administrators, with more than 25,000 pregnant women currently enrolled – many of whom may need to trave several hours to reach a medical clinic on a good day. The texts they receive are often life-changing for both mother and baby – for example, reminders to eat healthy foods, or to use mosquito nets to protect against potentially fatal dengue fever or malaria.

Marcia is a mother in Liquiçá District with three children. She began using the system during her third pregnancy. “I received information every week like reminding me that if I get sick I have to go to the clinic, or if there are any danger signs like fever or skin turning yellow that I have to bring my baby to the clinic for treatment,” she said. “Midwives also reminded me to get enough rest during my pregnancy. Before I registered for the program, I didn’t get this information.”

Rest is important but difficult for many pregnant women in Timor-Leste, as women often take on a large proportion of household duties and play a big role in hosting and attending traditional ceremonies. These are commonly held in Timorese culture, for anything from dowry exchange to the death of a family member. Carmelinda, a mother of two, is currently pregnant and often has to travel to the aldeias (sub-villages) for ceremonies with extended family. She says she appreciates Liga Inan as “even if I can’t go to the clinic, I still have information on how to take care of myself and my baby”.

For newborns and their mothers, the first month after birth carries the greatest risk of death. Newborns are 10 times more likely to die in Timor-Leste than in Australia and the maternal mortality rate is 36 times that of Australia . But an evaluation conducted in 2016 revealed that mothers living in Manufahi District, where the program was first piloted, were more than five times as likely to take their baby in for a checkup within two days of birth compared to a neighbouring district where Liga Inan wasn’t available. After the program began, Manufahi also showed a significant increase in babies delivered at a health facility with a skilled birth attendant.

The real-world impact through closer relationships between women and health providers is what Gabriela Leite-Soares, who leads Catalpa’s role in the program, believes is the most innovative aspect of the program. She says enhanced ability for women to access face-to-face care during their pregnancy, delivery and post-pregnancy is critical to the program’s success.

“A lot of times when people use the word ‘innovation’, they assume it has to do with technology,” she said. “But for me, this program is innovative not just due to the technology, but because of how it’s being used. One of the challenges in Timor-Leste is a lack of motivation for pregnant women to go to health providers. We’re working hard to change that by bringing patients closer to their health providers through two-way communication. When we strengthen communication between mothers and health providers, you also establish trust and that can increase the likelihood of women seeking help.”

Tanushree Rao is a communicator and advisor in international development, currently based in Timor-Leste. She also writes on the subjects of technology, innovation, global development and social impact.

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